Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Abstract

ObjectivesTo systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs) who underwent endovascular aneurysm repair (EVAR) to patients who underwent open surgical repair (OSR).MethodsThe Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay.ResultsA total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies) with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001). rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from −2.00 to −19.10 days, with the overall estimate being −5.25 days (95% CI = −9.23 to −1.26, P = 0.010). There was no publication bias and sensitivity analysis showed good reliability.ConclusionsEVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?

“…In a previous study, the mean hospital length of stay was 7 days after EVAR treatment of rAAAs [22]. Similar to that study, the mean hospital stay in the present study was 6.7 ± 3.5 days in the patients with a normal anatomy and 10.4 ± 15.5 days in patients with a hostile anatomy.…”

The Abdominal Aortic Aneurysm and Intraluminal Thrombus: Current Concepts of Development and Treatment

“…Likewise, rapid aneurysm growth with more than 10 mm per year represents another indication for early repair ( 4 ). In conclusion, these recommendations aim to prevent AAA rupture, a life-threatening event with mortality rates of approximately 65–85% ( 100 ).…”

Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

“…Since a metaanalysis by van Beek et al [87] showed that EVAR for rAAA repair is not inferior to OR in terms of short-term survival, it can therefore be recommended to use the same accustomed technique for rAAA as for the intact AAA. In the long term this means a further increase in EVAR for rAAA, especially since an additional literature meta-analysis including large retrospective multicenter studies, clearly favored the endovascular approach for rAAA with respect to in-hospital mortality [88].…”